Late-Onset Alcohol Abuse as a Presenting Symptom of Neurodegenerative Diseases

Article type: Research Article

Authors: de Paula França Resende, Elisa^{a; b} | Ketelle, Robin^c | Karydas, Anna^c | Allen, Isabel^{b; d} | Grinberg, Lea T.^{b; c} | Spina, Salvatore^{b; c} | Seeley, William W.^c | Perry, David C.^c | Miller, Bruce^{b; c} | Naasan, Georges^{b; e; *}

Affiliations: [a] Hospital das Clínicas da Universidade Federal de Minas Gerais – EBSERH, Belo Horizonte, Brazil | [b] Global Brain Health Institute based at University of California, San Francisco, CA, USA and Trinity College, Dublin, Ireland | [c] Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, USA | [d] Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA | [e] The Barbara and Maurice Deane Center for Wellness and Cognitive Health, Department of Neurology, Mount Sinai Hospitals, Icahn School of Medicine, New York, NY, USA

Correspondence: [*] Correspondence to: Georges Naasan, MD, Barbara and Maurice Deanne Center for Wellness and Cognitive Health, 5 East 98th Street, 720 C, New York, NY 10029, USA. Tel.: +1 347 882 1330; E-mail: Georges.Naasan@mssm.edu.

Abstract: Background:The association between lifetime alcohol abuse and a higher risk to develop dementia is well known. However, it is unknown whether older adults who begin abusing alcohol late in life have an underlying neurodegenerative disease. Objective:Identify the frequency of lifelong alcohol abuse (L-AA), late-onset alcohol abuse (LO-AA), and alcohol abuse as a first symptom of dementia (AA-FS) in patients with neurodegenerative diseases. Methods:Cross-sectional retrospective study of patients evaluated at an academic referral center with a clinical diagnosis of behavioral variant frontotemporal dementia (bvFTD), Alzheimer-type dementia (AD), and semantic variant primary progressive aphasia (svPPA) (n = 1,518). The presence of alcohol abuse was screened with the National Alzheimer’s Coordinating Center questionnaire. L-AA was defined as onset < 40 years, LO-AA as onset ≥40 years, and AA-FS was defined when the abuse started within the first three years from symptom onset. Results:The frequency of LO-AA was 2.2% (n = 33/1,518). LO-AA was significantly more frequent in patients with bvFTD than AD (7.5%, n = 13/173 versus 1.3%, n = 16/1,254, CI:1.0;11.4%), but not svPPA (4.4%, n = 4/91, CI: –4.4;10.7%). Similarly, AA-FS was more frequent in bvFTD patients than AD (5.7%, n = 10/173 versus 0.7%, n = 9/1,254, CI:0.5%;9.5%), but not svPPA (2.2%, n = 2/91, CI:–2.4;9.1%). Conclusion:LO-AA can be a presenting symptom of dementia, especially bvFTD. Alcohol abuse onset later in life should prompt a clinical investigation into the possibility of an underlying neurodegenerative process because delay in diagnosis and treatment may increase patient and caregiver burden. The results need to be interpreted with caution due to the limitations of the study.

Keywords: Alcohol-related problems, Alzheimer’s dementia, dementia, frontotemporal dementia

DOI: 10.3233/JAD-215369

Journal: Journal of Alzheimer's Disease, vol. 86, no. 3, pp. 1073-1080, 2022